Publication: The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries

Andis Graudins, Robert Meek, Dianna Egerton-Warburton, Ed Oakley, Robert Seith Annals of Emergency Medicine, Vol. 65, Issue 3, p248–254.e1 Published online: November 17, 2014

Objective

To describe and compare the characteristics of paracetamol poisoning in adolescent and adult patients.

Method

 

Descriptive retrospective case series of adolescent (12–17 years) and adult (>18 years) patients presenting to a metropolitan hospital network ED, diagnosed with paracetamol poi- soning from October 2009 to September 2013.

Results

There were 220 adolescent (median age 16 years, 47% treated with acetylcysteine [NAC]) and 647 adult presentations (median age 27 years, 42% treated with NAC) for pa- racetamol poisoning in the study period. Adolescent patients were more frequently women (89% vs 76%; odds ratio [OR] 2.4; 95% confidence in- terval [CI] 1.5–3.8) and ingested similar amounts of paracetamol (18 g) when requiring NAC treatment. Ado- lescents were more likely to ingest pa- racetamol as a single agent (53% vs 34%; OR 2.2; 95% CI 1.6–3.0) and less likely to ingest compound para- cetamol products than adults (18% vs 29%; OR 0.54; 95% CI 0.36–0.79). Adolescents were less likely to report accidental supratherapeutic ingestion of paracetamol (0.02% vs 10%; OR 0.23; 95% CI 0.09–0.58), or co-ingestion of prescription medica- tions (25% vs 43%; OR 0.4; 95% CI 0.31–0.62). Adolescents had more frequent histamine release reactions to NAC than adults (17% vs 8%; OR 2.3; 95% CI 1.2–4.5). No cases required liver transplantation or resulted in death.

Conclusion

Adolescents ingested com- parable amounts of paracetamol to adults, when presenting with deliber- ate self-poisoning. However, there were significant differences in co-ingested medications and the reason for inges- tion of paracetamol. Histamine reac- tions to NAC were more common in adolescents; however, most were mild. Overall, outcome was favourable in both cohorts.